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Restrictive allograft dysfunction rather than bronchiolitis obliterans syndrome had a major impact on the overall survival after living-donor lobar lung transplantation

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Abstract

Purpose

Chronic lung allograft dysfunction (CLAD) is a known long-term fatal disorder after lung transplantation. In this study, we evaluated the CLAD classification of the International Society for Heart and Lung Transplantation (ISHLT) for living-donor lobar lung transplantation (LDLLT).

Methods

We conducted a single-center retrospective review of data from 73 patients who underwent bilateral LDLLT between 1998 and 2019. Factors related to opacity on computed tomography (CT) and restriction on pulmonary function tests (PFTs) were also analyzed.

Results

Overall, 26 (36%) patients were diagnosed with CLAD, including restrictive allograft syndrome (RAS), n = 10 (38.5%); bronchiolitis obliterans syndrome (BOS), n = 8 (30.8%); mixed, n = 1 (3.8%); undefined, n = 2 (7.7%); and unclassified, n = 5 (19.2%). The 5-year survival rate after the CLAD onset was 60.7%. The survival of patients with BOS was significantly better than that of patients with RAS (p = 0.012). In particular, patients with restriction on PFT had a significantly worse survival than those without restriction (p = 0.001).

Conclusions

CLAD after bilateral LDLLT does not have a major impact on the recipient survival, especially in patients with BOS. Restriction on PFT may predict a particularly poor prognosis in patients with CLAD after bilateral LDLLT.

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Acknowledgements

We would like to thank Editage (www.editage.com) for the English language editing.

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Author notes

  1. Shinji Otani

    Present address: Department of Cardiovascular and Thoracic Surgery, Ehime University Hospital, 454 Shitsukawa, Toon, Ehime, 791-0295, Japan

Authors and Affiliations

  1. Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, Okayama, 700-8558, Japan

    Kei Matsubara, Shinji Otani, Haruchika Yamamoto, Kohei Hashimoto, Shin Tanaka, Kazuhiko Shien, Ken Suzawa, Kentaroh Miyoshi, Hiromasa Yamamoto, Mikio Okazaki, Seiichiro Sugimoto & Shinichi Toyooka

  2. Latner Thoracic Surgery Research Laboratories, Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada

    Haruchika Yamamoto

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Contributions

Participated in research design: KM, SO, SS, Participated in the writing of the paper: KM, SO, KS, KS, KM, HY, MO, ST, Participated in the performance of the research: KM, SO, HY, Participated in the data analysis: KM, SO, KH, ST.

Corresponding author

Correspondence to Shinji Otani.

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Matsubara, K., Otani, S., Yamamoto, H. et al. Restrictive allograft dysfunction rather than bronchiolitis obliterans syndrome had a major impact on the overall survival after living-donor lobar lung transplantation. Surg Today 54, 317–324 (2024). https://doi.org/10.1007/s00595-023-02729-2

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